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Abstract
Chemodenervation of cervical musculature using botulinum neurotoxin (BoNT) is established as the gold standard or treatment of choice for management of Cervical Dystonia (CD). The success of BoNT procedures is measured by improved symptomology while minimizing side effects and is dependent upon many factors including: clinical pattern recognition, identifying contributory muscles, BoNT dosage, and locating and safely injecting target muscles. In patients with CD, treatment of anterocollis (forward flexion of the neck) and anterocaput (anterocapitis) (forward flexion of the head) are inarguably challenging. The longus Colli (LoCol) and longus capitis (LoCap) muscles, two deep cervical spine and head flexor muscles, frequently contribute to these patterns. Localizing and safely injecting these muscles is particularly challenging owing to their deep location and the complex regional anatomy which includes critical neurovascular and other structures. Ultrasound (US) guidance provides direct visualization of the LoCol, LoCap, other cervical muscles and adjacent structures reducing the risks and side effects while improving the clinical outcome of BoNT for these conditions. The addition of electromyography (EMG) provides confirmation of muscle activity within the target muscle. Within this manuscript, we present a technical description of a novel US guided approach (combined with EMG) for BoNT injection into the LoCol and LoCap muscles for the management of anterocollis and anterocaput in patients with CD.
Highlights
IntroductionDystonia isisa neurological a neurological movement disorder insustained which sustained ormuscle repetitive muscleDystonia movement disorder in which or repetitive contractions contractions result in twisting and repetitive movements or abnormal fixed posture [1].Cervical result in twisting and repetitive movements or abnormal fixed posture [1]
The longus Colli (LoCol) and longus capitis (LoCap) lie in the deep, anterior cervical compartment, lying in a groove created by the anterior tubercle of the transverse processes (TvP) and vertebral body
Supporting functional anatomic studies in unimpaired individuals suggest that the deeper cervical flexor muscles, including the LoCol and LoCap play a critical role in head and neck flexion at the craniocervical junctions [17]
Summary
IntroductionDystonia isisa neurological a neurological movement disorder insustained which sustained ormuscle repetitive muscleDystonia movement disorder in which or repetitive contractions contractions result in twisting and repetitive movements or abnormal fixed posture [1].Cervical result in twisting and repetitive movements or abnormal fixed posture [1]. Dystonia isisa neurological a neurological movement disorder insustained which sustained ormuscle repetitive muscle. Dystonia movement disorder in which or repetitive contractions contractions result in twisting and repetitive movements or abnormal fixed posture [1]. Cervical result in twisting and repetitive movements or abnormal fixed posture [1]. 8–12 cases per million person-years [2]. An incidence of 8–12 cases per million person-years [2]. The neck postures, postures, involuntary involuntary head head and and neck neck movements, movements, tremor, neck pain, and even involved muscular hypertrophy [3]. CD can be associated with similar tremor, neck pain, and even involved muscular hypertrophy [3]. CD can be associated with similar dystonic symptoms in nearby muscles, such as those in the shoulder, upper back and/or face
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